Instruments for osteolysis repair

ABSTRACT

A plug for plugging a hole of a bone or implant body during injection of an osteoregenerative material comprising, generally, a plug body, the plug body configured to plug a hole of the body to prevent osteoregenerative material from leaking through the hole, and a tail, the tail attached to the plug body for use in removing the plug body from the hole. In one embodiment, the plug body has an insertion cavity on a trailing end thereof for use in inserting the plug into a hole of the body. The plug body preferably has a frustoconical configuration. The plug body is preferably made of a resilient material, such as silicon.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.11/353,313, filed Feb. 14, 2006, entitled “Instruments for OsteolysisRepair,” and which claims priority to and incorporates by reference U.S.Provisional Patent Application Ser. No. 60/654,696, filed Feb. 21, 2005.

FIELD OF THE INVENTION

The present invention relates to bone repair, and more particularly torepair of bone afflicted with osteolysis and other degenerative boneconditions.

BACKGROUND OF THE INVENTION

Osteolysis is a medical condition involving dissolution of bone.Unfortunately, osteolysis often occurs in the bone adjacent to anorthopedic implant, such as a hip or knee implant. Osteolysis 15 formsosteolytic lesions or voids in the bone. Osteolytic lesions aretypically soft and spongy, and are unsupportive of orthopedic implants.An osteolytic lesion can cause a well-fixed implant to loosen. To treatosteolysis in the area of an implant, it is often necessary to conduct arevision surgery in which the old implant is removed, the lesion iscleaned out by debriding the local area, and then a larger revisionimplant is put in. To gain fixation, the revision implant requiressubstantial hardware 20 to compensate for the significant bone loss.

Osteolytic lesions can occur in many other parts of the body whereimplants have been implanted, e.g. humerus, tibial plateau, distalfemur, and acetabulum. Accordingly, the need to treat osteolytic bonelesions after joint replacement surgery is a widespread problem.

OBJECTS AND SUMMARY OF THE INVENTION

It is an object of the invention to provide an improved treatment ofosteolytic bone lesions.

It is another object of the invention to provide an improved debridementof osteolytic bone lesions that does not require removal of a previousimplant.

It is an object of the invention to avoid or delay revision surgery bydebriding osteolytic bone lesions and regenerating bone in the lesions.

It is an object of the invention to conserve bone by preserving andregenerating bone in osteolytic lesions.

In order to achieve the foregoing and other objectives and advantages ofthe invention, a plug for plugging a hole of a bone or implant bodyduring injection of an osteoregenerative material is providedcomprising, generally, a plug body, the plug body configured to plug ahole of the body to prevent osteoregenerative material from leakingthrough the hole, and a tail, the tail attached to the plug body for usein removing the plug body from the hole. The tail is preferably formedfrom a cord. A portion of the cord is preferably embedded in the plugbody. A portion of the cord preferably traverses the plug body from aleading end to a trailing end of the plug body. A knot is preferablyformed in the portion of the cord that is embedded in the plug body. Theplug can be provided with a second tail, with the second tail beingattached to the plug body for use in removing the plug body from thehole. The tails are preferably formed from a single cord, with a portionof the cord passing through the body of the plug.

In one preferred embodiment, the plug body has an insertion cavity on atrailing end thereof for use in inserting the plug into a hole of thebody. The plug body preferably has a frustoconical configuration, andpreferably has a shoulder on a trailing end. The plug body is preferablymade of a resilient material. The resilient material is preferablysilicon, and is more preferably an implant grade silicon.

A method of repairing an osteolytic lesion associated with an implant isprovided comprising plugging holes of the implant with one or moreremovable plugs prior to injecting a bone regenerative material into thelesion, such that the plugs prevent the bone regenerative material fromleaking through the holes. The plugs can be provided with tails, and thetails can be used to remove the plugs from the implant.

A kit can be provided for treating osteolysis and other degenerativebone conditions. In a preferred embodiment, the kit includes at leastone plug, a means for removing the plug from a hole, and a boneregenerative material. The kit preferably includes an osteolysis brushconfigured for use in debriding osteolytic material, as well as amulti-radius bender. The kit also preferably includes one or more of acurette, a cannula configured for use in suctioning osteolytic materialout of the osteolytic lesion, a syringe for injecting osteoconductivematerial into the osteolytic lesion, a syringe loader for transferringthe osteoconductive material to the syringe, and a syringe needle.

Methods of debriding osteolytic material from an osteolytic lesion inthe vicinity of an acetabular shell implant are provided. One preferredmethod comprises inserting a curette through at least one hole of theacetabular shell in order to gain access to the osteolytic lesionlocated behind the shell, and manipulating the curette through the holeto thereby scrape osteolytic material from the lesion. The curette canbe bent in order to reach areas of the osteolytic lesion. Additionalosteolytic material can be removed by inserting a brush through at leastone of the holes of the acetabular shell and manipulating the brush toentrap and remove residual particles of osteolytic material from theosteolytic lesion. Loose osteolytic material can be removed by insertinga cannula through at least one of the holes of the acetabular shell andsuctioning the osteolytic material through the cannula.Osteoregenerative material can then be injected behind the shell inorder to fill the lesion and regenerate bone. In order to preventosteoregenerative material from seeping through the holes, the holes ofthe implant can be plugged prior to injecting the osteoregenerativematerial behind the shell. A cannula can be inserted through a plug bodyand osteoregenerative material can be injected through the plug.

The foregoing and other objects, features, aspects and advantages of theinvention will become more apparent from the following detaileddescription of the invention when considered in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1I provide views of preferred embodiments of plugs for use inosteolysis repair.

FIG. 2 provides a view of one preferred embodiment of an osteolysisbrush for use in osteolysis repair.

FIGS. 3A-3H provide views of one preferred embodiment of a multi-radiusbender for use in osteolysis repair.

FIGS. 4A-4G show preferred methods of osteolysis repair using theinstruments of the invention.

FIG. 5 shows a schematic view of instruments of a kit for osteolysisrepair.

PREFERRED EMBODIMENTS OF THE INVENTION

In the following detailed description of the preferred embodiments,reference is made to the accompanying drawings which form a part hereof,and in which are shown by way of illustration specific embodiments inwhich the invention may be practiced. It is to be understood that otherembodiments may be utilized and structural changes may be made withoutdeparting from the scope of the present invention.

The present invention is directed to an osteolysis kit and the variousindividual components of the kit.

Plugs

As shown in FIGS. 1A-1I, one aspect of the invention is a removable plug1. As will be described in further detail below, the plugs 1 are used totemporarily plug holes in an implant or bone while injecting anosteoregenerative material into an osteolytic void located behind oradjacent the implant or bone. The plug 1 will be discussed withreference to a hip revision procedure in which the osteolytic site isaccessed through holes in an acetabular shell. However, it will beappreciated that the concepts disclosed herein can be used with any typeof implant through which an osteolytic site can be accessed throughholes in the implant (e.g. knee implants; shoulder implants), as well asthrough bone holes that communicate with an osteolytic lesion.

The body 10 of the plug 1 preferably has a frustoconical configurationhaving a conical side wall 14 tapering toward a flat bottom/distal wall12. The conical side wall 14 is shaped such that a leading or distalportion of the side wall 14 has a diameter less than that of the shellholes, while a trailing or proximal portion of the side wall 14 has adiameter greater than that of the shell holes, such that a section ofthe side wall 14 serves to plug the shell hole. The conical side wall 14allows a single size plug 1 to plug a plurality of sizes of shell holes,thus reducing inventory in an osteolysis kit. The side wall 14 could beprovided with annular ribs (not shown) or other retaining structures. Toprevent over-insertion of the plug body 10, the plug body is preferablyprovided with a shoulder 16 extending along the rim 15 of the plug body10.

As shown in the top view of FIG. 1C and the cross-section view of FIG.1E, the plug body 10 preferably has an insertion cavity 20 through atrailing end of the plug body 10. The insertion cavity 20 is preferablya bore and is used to insert the plug body 10 into the hole of a shell.As shown in FIGS. 1F and 4F, the tip of a blunt instrument or insertiontool 97 is inserted into the insertion cavity 20, and the instrument isthen used to force the plug body 10 into a shell hole.

To assist in removing the plug body 10 from the hole, the plug body 10is preferably provided with a tail 30. As shown in FIG. 1, the tail 30is preferably formed as a portion of a cord 31. FIG. 1E provides detailsof a preferred embodiment of a connection between the plug body 10 andthe tail 30. As shown in the cross-section view of FIG. 1E, a distalportion 31D of the cord 31 is embedded in a solid bottom portion 13 ofthe plug body 10. The tail 30 extends through the rim 15 of the plugbody 10 and into the solid bottom portion 13. FIG. 1F provides detailsof an alternative preferred embodiment in which the tail 30 enters theplug body 10 through an area inside of the rim 15. As shown in FIG. 1F,the tail 30 may traverse the body 10 of the plug 1. As also shown inFIG. 1F, the tail 30 can pass through the axis or slightly off-axis ofthe plug body 10, in which case the insertion cavity 20 is formedadjacent to, rather than along, the axis of the plug body 10. Thecross-section view of FIG. 1G shows an alternative preferred embodimentin which the tail 30 is integrally molded from the material that formsthe plug body 10. The tail 30 of the embodiment of FIG. 1G has a shortlength, such as a stub that can be grabbed between the thumb andforefinger.

The cross-section view of FIG. 1H shows an alternative preferredembodiment in which a knot 32 is formed in a distal portion of the cord31. The body 10 of the plug 1 is molded around the knot 32. The knot 32assists in retaining the cord 31 in the plug 1. The cross-section viewof FIG. 1I shows an alternative preferred embodiment in which the cord31 loops through the body 10 of the plug 1, forming a pair of tails 30.

The plug 1 is made of a resilient material, such as a Shore A 55durometer instrument or implant grade silicone or C-FLEX polymer. Thetail 30 is preferably made of an implantable, braided polyester cord 31.In one manufacturing method, the plug 1 is formed with excess cord 30extending from the bottom or distal wall 12 of the plug. The excess cordis then cut off such that the cord 30 does not extend beyond the bottomwall 12. The tail 30 is preferably of a length sufficient to allow asurgeon to securely grasp the tail 30 for use in removing the plug 1,such as by wrapping the tail 30 around a finger. The tail 30 ispreferably between about 20 to 40 cm in length, and is preferably 30.5cm in length. As mentioned above, much shorter tails can be used. Ashort tail may be preferable for plugs 1 in which the tail 30 isintegrally molded from the same material that forms the plug body 10(e.g. a silicon body 10 and tail 30).

Osteoregenerative materials that can be used with the plugs 1 includeosteoconductive materials (e.g. calcium sulfate; calcium phosphates;hydroxyapatite) as well as osteoinductive materials (e.g. calciumsulfate plus demineralized bone matrix; autograft cancellous bone;

allograft cancellous bone). The osteoregenerative material is preferablyapplied in an injectable form (e.g. MIIG® injectable bone paste,available from applicant Wright Medical Technology, Inc. of Arlington,Tenn.). Cancellous chips or pellet forms of osteoregenerative materialscan also be used (e.g. OSTEOSET® bone graft substitute, available fromapplicant Wright Medical Technology, Inc.), since the plugs 1 will alsoserve to retain these materials.

Brush

To assist in removing osteolytic material from the osteolytic lesion,the osteolysis kit of the invention is preferably provided with aspecially configured osteolysis brush. FIG. 2 shows a preferredembodiment of an osteolysis brush 40. The osteolysis brush 40 has abristle portion 43 affixed to a lengthwise shaft 41. As indicated inFIG. 2B, the bristle portion 43 is configured to pass through an implanthole, such as through bristles radiated from the axis of the shaft 41 ina circumferential or twisted configuration. Viscous, gooey forms ofosteolytic material become ensnared in the bristles 43, such that thebrush 40 efficiently removes osteolytic material. The bristles 43 arepreferably made of natural nylon grade 612 having a fiber size of about0.25 mm. The shaft 41 is made of a strong but flexible material, such asinterwoven steel wires, which allows the bristle portion 43 to bemanipulated within the osteolytic lesion through an implant or bonehole, such as a shell hole. The shaft is preferably between about 20 to30 cm long, and is preferably 25.4 cm long.

Ring Curette

As shown in FIG. 4A, the osteolytic kit of the invention preferablyincludes a ring curette 80 having a ring tip 82 joined to a handle 88 bya connecting shaft 86. The ring tip 82 has an opening passing throughthe tip 82. The ring tip 82 provides an effective structure for scrapingosteolytic material from the surface of the lesion. Ring curettes areknown and are used for various medical procedures, but as far as theapplicant has been able to determine, ring curettes have not previouslybeen used to remove osteolytic material. Conventional ring curettestypically have straight shafts and the ring tip is joined to the shaftat a straight or fixed angle. Thus, ring curettes are generally rigidand difficult to bend. Since osteolytic lesions and their associatedimplants come in a multitude of shapes, it is often necessary to bendthe curette in order to achieve a workable configuration for cleaningout the lesion. Curette manipulation is particularly necessary whenattempting to navigate through an implant hole and behind the implantsurface to scrape off the osteolytic material.

Multi-Radius Bender

To facilitate bending of curettes and cannulas, the osteolysis kit ofthe invention is preferably provided with a multi-radius bender 60 ofthe type shown in FIG. 3. The embodiment shown in FIG. 3 provides fiveset bending radiuses R₁-R₅. Additional or fewer radii could be provided,but it is believed that the embodiment shown in FIG. 3 provides anoptimum balance between bending options, instrument size, andcomplexity. In the preferred embodiment shown in FIG. 3A, the bender 60includes a base portion 62, a generally lengthwise body portion 64, anda bender portion 68. The body portion 64 may comprise a pair of parallelcolumns forming a lengthwise slot 65 in the bender 60. The body portion64 and the slot 65 assist in handling the instrument. For example, asurgeon working with wet gloves can secure his or her fingers in theopening 65 while grasping one or both of the column portions 64. Asindicated in FIG. 3A, the opening 65 can be provided with contourededges, such as along upper and lower ends of the opening 64. Anotheradvantage of the opening is that it reduces the amount of material usedto manufacture the bender 60.

In the embodiment shown in FIG. 3A, a plurality of bending surfaces orbending radiuses R₁-R₄ are formed along an upper surface of the benderportion 68. Each of the radiuses R has a selected radius. However, ascan be seen in FIG. 3A, pairs of radiuses are preferably formed along ashared bend, so as to reduce the dimensions of the instrument. Forexample, the cross-section view of FIG. 3E shows that radius R₁ andradius R₂ are formed along a common bend, yet have distinctly differentradiuses. Radius R₂ has a longer radius, and consequently provides amore gentle curve than radius R₁. As can be seen in FIG. 4B, the shaft86 of a curette or cannula is placed on a selected radius R and thenbent along the radius R so as to achieve a shaft 86 curvature thatgenerally matches that of the selected radius R. In FIG. 4B, the shaft86 is being bent along bending radius R₄.

In order to retain the shaft 86 in position along the selected radius Rduring bending, the bender 60 is provided with a shaft holder 70. Asindicated in FIGS. 3B and 4B, at least a portion of the holder 70 isspaced to closely receive a curette shaft 86 or cannula between theshaft holder 70 and the various bending radiuses R. As shown in FIG. 3B,the shaft holder 70 is attached to the bender portion 68 by a neck 72.The neck 72 can be configured for use in seating and retaining the shaft86 along bending radiuses R₂ and R₄.

In order to provide yet another bending radius R, a lower surface of theshaft holder 70 is preferably curved into a bending radius R₅. Unlikethe other radiuses R, the shaft holder bending radius R₅ is used bybending the curette or cannula upward, in a direction away from the base62 of the bender 60.

To provide aggressive bending of instruments, the bender 60 is alsopreferably provided with at least one instrument tip bend aperture 63.In a preferred embodiment shown in FIG. 3E, the instrument tip bendaperture 63 is formed through the base portion 62 of the bender 60, butthe instrument tip bend aperture 63 can be formed at other locations onthe bender 60. As shown in FIG. 3E, the instrument tip bend aperture 63preferably includes a curved portion for use in forming a smooth bend ofthe curette tip 82 or cannula. As further shown in FIG. 3E, the bender60 is preferably provided with two instrument tip bend apertures 63. Theinstrument tip bend apertures 63 are preferably different sizes for usein accommodating different sized instrument tips 82. As shown in FIG.4A, the instrument tip bend aperture 63 is used by placing a tip 82 ofan instrument, such as a curette or cannula, into the aperture 63 andthen bending the tip (or an adjoining portion of the curette shaft 86 orcannula) against the edge of the aperture 63. As indicated in FIG. 4A,different selected degrees of bend can be achieved, depending primarilyon how far the instrument handle 88 is moved relative to the aperture63. The step of bending the instrument tip 82 is preferably carried outprior to the step of bending the shaft 86, since a bent shaft 86 willmake it more difficult to achieve a selected degree of bend in the tip82 area.

The multi-radius bender 60 can be used to readily form more aggressivetip and shaft bends than could be obtained by bending the instrument 80by hand. The uni-body construction of the multi-radius bender provides adurable structure that can be autoclaved and reused, or readilymanufactured in a disposable embodiment. Further, through experience, asurgeon will develop familiarity with the set curvatures of the radiusesR, and thus will be able to readily attain consistent degrees ofbending.

Use of Instruments

In operation, the osteolysis kit of the invention is used in amulti-part procedure for debridement of osteolytic material from bonelesions. Methods of using the osteolysis kit will be discussed withreference to a hip revision, but, as mentioned above, the methods can beused for osteolysis repair with other types of implants, such as kneeand shoulder implants. The original cup liner is removed from the shell200 using techniques known to those of skill in the art. The ringcurette 80 can then be used to clean the lesion 100. As shown in FIG.4A, a tip 82 of a ring curette 80 is placed in the tip bender 63. Asshown in FIG. 4B, a distal portion of the shaft 86 of the curette 80 isthen placed in a selected radius R of the bender 60. In FIG. 4B, theshaft 86 has been placed for bending along radius R₄. By pulling down onthe handle 88 of the curette 80, the surgeon can readily bend a distalportion of the shaft 86 into a bend that substantially matches theradius of the selected radius R.

As shown in FIG. 4C, the shaft 86 of the curette 80 is inserted througha hole of the acetabular shell 200 in order to gain access to theosteolytic lesion 100 located behind the shell 200. The curette 80 isthen manipulated to scrape osteolytic material 102 from the lesion 100.The osteolytic material 102 is shown in representative form in thedrawings. Osteolytic material 102 typically coats the entire surface ofthe lesion 100. The open bore of the ring tip 82 of the curette 80allows osteolytic material to readily pass through the tip 82 duringscraping, which is believed to yield a more efficient scraping process.If the surgeon has difficulty accessing a particular area of the lesion100, the surgeon has the option of removing the curette 80 from thelesion 100, bending a second curette 80 into a desired configuration inthe manner described herein, and inserting the second curette 80 intothe lesion 100 for scraping of osteolytic material 102. Straightcurettes 80 can be used, but it is believed that bent curettes 80 willprovide better results, since they can be configured to reach areas ofthe lesion 100 that would be difficult or impossible to reach with astraight curette 80.

As shown in FIG. 4D, once osteolytic material 102 has been scraped fromthe lesion 100, the brush 40 can be inserted into the lesion 100 for usein brushing the wall of the lesion 100 to remove residual particles ofosteolytic material 102. As indicated in FIG. 4D, the brush 40 not onlycleans the walls, but is configured to entrap osteolytic material 102 inthe bristles 43, such that the brush 40 can be used to remove osteolyticmaterial 102.

As shown in FIG. 4E, a metal cannula 98 is inserted into the lesion 100and is used to suck out the loose osteolytic material 102. It may benecessary to bend the cannula 98, such as by using the bender 60, inorder to access substantially all areas of the lesion 100. After suctionof loose osteolytic material 102, it may be necessary to repeat some orall of the foregoing steps of scraping, brushing, and suction in orderto insure that substantially all osteolytic material 102 has beenremoved from the lesion 100. Depending on the circumstances of theparticular case, it may be preferable to carry out the cleaning steps ina different order, e.g. suction prior to brushing.

As shown in FIG. 4F, once a sufficient amount of osteolytic material 102has been removed from the lesion 100, the plugs 1 are used to plug theholes in the implant 200 for use in applying an osteoregenerativematerial. In the embodiment shown in FIG. 4F, the implant 200 is anacetabular shell 200, and the holes are the holes that are used tosecure the shell 200 to the hip bone, such as with bone screws. Theplugs 1 can be inserted into the shell holes by hand. However, as shownin FIG. 4F, the plugs are preferably inserted by placing a blunt tip ofan insertion instrument 97 into the plug's insertion cavity 20, and thenmanipulating the insertion instrument 97 to insert the plug 1 into aselected hole. The configuration of the plugs 1, including the resilientmaterial from which they are made, allows the plugs 1 to be installedquickly and with little effort on the part of the surgeon. In apreferred embodiment, all but one of the shell holes are plugged, suchthat the open hole provides access to the osteolytic lesions.Alternatively, all of the holes can be plugged, in which case aninjection cannula can be inserted through the body portion 10 of one ofthe plugs and the bone regenerative material can be injected through theplug body 10. In situations involving a small lesion 100, some of theimplant holes may lie over normal bone, in which case plugs 1 are onlyused in the holes that overlay the lesion 100. Additionally,osteoregenerative material 310 may be applied to the lesion 100 otherthan through a hole of the implant, such as through a separate portalincision or by passing the injection cannula 301 around a side of theimplant.

FIG. 4G shows the use of a syringe 300 and associated cannula 301 toinject an osteoregenerative material into the lesion 100. Because theshell holes are plugged with the plugs 1 of the invention, theosteoregenerative material cannot leak through the shell holes.Osteoregenerative material 310 is preferably inserted into the lesion100 until the lesion 100 is substantially completely filled withosteoregenerative material 310. Because the shell holes are plugged,osteoregenerative material 310 typically will not start to leak out ofthe open shell hole until the void is full or substantially full, atwhich point excess material 310 is preferably forced through the openhole. Thus, the plugs 1 assist in determining when the void of thelesion 100 has been completely filled with osteoregenerative material310. The plugs 1 are removed from the shell 200 simply by pulling on thetails 30, a procedure that takes only moments to perform. The plugs 1can be removed at the discretion of the surgeon, such as when the voidhas been sufficiently filled or the osteoregnerative material hashardened sufficiently. Once the plugs 1 have been removed, the surgeonhas completed the osteolysis repair and can proceed with subsequentstages of the revision procedure, including replacing the implant, whichin the method shown in FIGS. 4A-4G would entail impacting a replacementcup liner into the shell 200.

As mentioned above, osteolytic conditions can occur with other types ofimplants. For example, in a knee implant, osteolysis can occur under thetibial base and along the stem of the tibial base. If the tibial basehas fixation holes, it is possible to remove the polyethylene bearingsurface, debride osteolytic material and inject osteoregenerativematerials into the lesion through the holes using the methods describedherein, and then insert a new polyethylene bearing surface into thetibial base. With implants that do not have holes, it will be possiblein some circumstances to access the underlying lesion by working aroundthe edge of the implant or through a hole in the bone. In suchcircumstances, it may be useful to plug bone holes with plugs 1 toassist with injection of osteoregenerative material.

In a preferred embodiment, the osteolysis kit of the invention includesa set of plugs 1, a means for debriding osteolytic material, and anosteoregenerative material 310. The osteoregnerative material ispreferably an osteoconductive and/or osteogenic material. The kitpreferably includes additional components, such as an osteolysis brush40; a curette 80; a multi-radius bender 60; a blunt metal cannula 98configured for use in suctioning osteolytic material out of theosteolytic lesion; a syringe 300 for injecting osteoconductive materialinto the osteolytic lesion; a syringe loader 302 for transferring theosteoconductive material to the syringe; and a syringe needle 301. Thekit may also include instruments for removing the liner from the shell.All or part of the components of the kit are preferably disposable. Thecomponents of the kit are preferably arranged in a convenient format,such as in a surgical tray or case. However, the kit components do nothave to be packaged or delivered together, provided that they areassembled or collected together in the operating room for use at thetime of surgery.

A preferred bioresorbable material for use in the invention is aninjectable form of calcium sulfate (CaSO₄). An acceptable injectableform of calcium sulfate is MIIG® injectable bone paste, which is sold byWright Medical Technology, Inc. of Arlington, Tenn., the assignee of thepresent patent application. MIIG® injectable bone paste has superiorcompressive strength, is completely resorbable, regenerates bone, and iscapable of passing through very small needles under manually appliedpressure. While results will vary, the osteoconductive material may beresorbed and replaced by bone within twelve weeks. In preferred cases,use of the invention will halt or delay osteolysis.

Although the present invention has been described in terms of specificembodiments, it is 15 anticipated that alterations and modificationsthereof will no doubt become apparent to those skilled in the art. It istherefore intended that the following claims be interpreted as coveringall alterations and modifications that fall within the true spirit andscope of the invention.

1-18. (canceled)
 19. A plug for plugging a hole of a bone or implantbody during injection of an osteoregenerative material, comprising: aplug body formed from a resilient material, said plug body having afrustoconical configuration narrowing from a trailing end to a leadingend for use in plugging a selected hole of the implant body to therebyprevent osteoregenerative material from leaking through the hole, and ashoulder extending along a rim of said trailing end of said plug body, atail formed from a cord, a distal portion of said cord embedded in saidplug body for use in removing the plug body from the hole, said cordextending from said trailing end of said plug body, and said plug bodyhaving an insertion cavity on said trailing end for use in insertingsaid plug into a selected hole of the body.
 20. The plug of claim 19,wherein said cord is embedded in said plug body substantially along anaxis of said plug body and said insertion cavity is formed substantiallyalong said rim of said plug body.
 20. (canceled) 21-26. (canceled)
 27. Amethod of debriding osteolytic material from an osteolytic lesion in thevicinity of an acetabular shell implant, the shell having fixation holestherethrough, comprising, inserting a curette through at least one holeof the acetabular shell in order to gain access to the osteolytic lesionlocated behind the shell, manipulating the curette through the hole tothereby scrape osteolytic material from the lesion, inserting a brush,said brush configured to entrap osteolytic material in bristles of thebrush, through at least one of the holes of the acetabular shell,manipulating the brush to entrap and remove residual particles ofosteolytic material from the osteolytic lesion, inserting a cannulathrough at least one of the holes of the acetabular shell, andsuctioning loose osteolytic material through said cannula.
 28. Themethod of claim 27, further comprising bending said curette in order toreach areas of the osteolytic lesion.
 29. The method of claim 27,further comprising plugging at least one of the fixation holes of theshell and injecting an osteoregenerative material behind the shell, saidplugs preventing said osteoregenerative material from seeping throughthe fixation holes.
 30. The method of claim 29, wherein all of the holesare plugged, and further comprising inserting a cannula through one ofsaid plugs and injecting said osteoregenerative material through saidplug.
 31. The method of claim 28, wherein curette is bent by insertingthe curette into a multi-radius bender.
 32. The method of claim 31,wherein the multi-radius bender comprises a plurality of bendingradiuses on an upper surface of a bending portion.
 33. The method ofclaim 32, wherein the multi-radius bender comprises an instrument tipbend aperture.
 34. A multi-radius bender comprising: a base portion; alengthwise body portion coupled to the base portion, the lengthwise bodyportion defining a bending portion at a first end, the bending portioncomprising a plurality of bending surfaces each defining a bendingradius; and a shaft holder coupled to the plurality of bending surfacesconfigured to receive a curette shaft.
 35. The multi-radius bender ofclaim 34, wherein a first set of the bending radii comprise a sharedbend.
 36. The multi-radius bender of claim 35, wherein a second set ofthe bending radii comprise an unshared bend.
 37. The multi-radius benderof claim 34, further comprising a first instrument tip bend apertureconfigured to bend a curette tip at a first predetermined angle.
 38. Themulti-radius bender of claim 37, wherein the first instrument tip bendaperture is formed through the base portion.
 39. The multi-radius benderof claim 37, further comprising a second instrument tip bend apertureconfigured to bend the curette tip at a second predetermined angle. 40.A method of repairing an osteolytic lesion associated with an implant,comprising: bending a shaft of a curette to a predetermined angle usinga multi-radius bender; inserting the curette through at least one holeof the implant; and manipulating the curette through the hole to therebyscrape osteolytic material from the lesion.
 41. The method of claim 40,further comprising: inserting a brush through at least one hole of theimplant, wherein the brush is configured to entrap osteolytic materialin the bristles of the brush through at least one of the holes of theimplant; and manipulating the brush to entrap and remove residualparticles of osteolytic material from the osteolytic lesion.
 42. Themethod of claim 41, further comprising: inserting a cannula through theat least one hole of the implant; and suctioning loose osteolyticmaterial through the cannula.
 43. The method of claim 42, furthercomprising plugging at least one of the holes of the implant andinjecting an osteoregenerative material behind the implant using a plug,wherein the plug prevents the osteoregenerative material from seepingthrough the at least one plugged hole.
 44. The method of claim 43,wherein all holes of the implant are plugged, and further comprisinginserting a cannula through one of the plugs to inject theosteoregenerative material through said plug.
 45. The method of claim40, wherein the shaft of the curette is bent by inserting the shaft intoa shaft holder formed on the multi-radius bender and is bent along oneof a plurality of bending surfaces of the multi-radius bendercorresponding to the predetermined angle.
 46. The method of claim 40,wherein the shaft of the curette is bent by inserting a tip of thecurette into an instrument tip bend aperture and bending the shaft tothe predetermined angle.
 47. A kit for treating an osteolysis and otherdegenerative bone conditions comprising: a ring curette comprising astructure for removing osteolytic material from a surface of a lesion; amulti-radius bender configured to bend a shaft of the ring curette to aplurality of predetermined angles; and a frustoconical plug having atrailing end that tapers to an insertion end including a solid shoulderoutwardly extending from the trailing end and a tail attached to andextending from the trailing end.
 48. The kit of claim 47, wherein themulti-radius bender comprises: a base portion; a lengthwise body portioncoupled to the base portion, the lengthwise body portion defining abending portion at a first end, the bending portion comprising aplurality of bending surfaces each defining a bending radius; and ashaft holder coupled to the plurality of bending surfaces configured toreceive a curette shaft.
 49. The kit of claim 47, wherein a first set ofthe bending radii of the multi-radius bender comprise a shared bend. 50.The kit of claim 49, wherein a second set of the bending radii of themulti-radius bender comprise an unshared bend.
 51. The kit of claim 47,wherein the multi-radius bender further comprises a first instrument tipbend aperture configured to bend a curette tip at a first predeterminedangle.
 52. The kit of claim 51, wherein the first instrument tip bendaperture is formed through the base portion.
 53. The kit of claim 51,further comprising a second instrument tip bend aperture configured tobend the curette tip at a second predetermined angle.
 54. The plug ofclaim 19, wherein said cord is embedded in said plug body substantiallyalong said rim of said plug body and said insertion cavity is formedsubstantially along an axis of said plug body.